Brow Lamination|Lash Lift Consent Form
ELKE VON FREUDENBERG SALON 1140 BROADWAY NY NY 917 475 6845
Date of Birth
Keratin Lash Lift
I understand there are risks associate with having a lash lift. I further that as part of the procedure, eye irritation, eye pain, eye itching,discomfort and rare cases eye infection or blurriness could occur. I agree that if I experience any of these medical conditions with my eyes that I will contact my technician and consult a physician at my own expense
I understand that even though my technician perms the lashes/laminates the brows using proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my skin/eyes or require a physician's follow-up care.
I understand and agree to the care instructions provided by my technician for the use and care of my brow lamination, permed and or tinted eyelashes. I realize and accept the consequences of failure to adhere to these instructions may cause the service benefits to not last as long as told.
Lash Lift- I am informing my stylist of the following conditions
I understand and consent to having my eyes closed and covered for the duration of the 60 minute lash lift procedure
Contact Lens Wearer
Use of oil-contanting sunscreen or moisturizer around the eyes
Recurrent eye or tear duct infections
Use of eyedrops, prescription or over the counter
Allergies or sensitivities to instruments, fumes, tapes, cleaners, eye gel pads, adhesives and removers that could cause my eyes to water and blink excess
History of Chemotherapy
Dry eyes or Sjorgen's Syndrome
Other medical conditions which would prohibit or compromise the process and retention of this eyelash perm
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